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Oura’s Harpreet Rai on a Ring That May Change Covid-19 Detection

Episode Summary

This week Harry speaks with Oura CEO Harpreet Rai, who’s leading an effort to explore how a wearable sleep-monitoring device—the Oura Ring—can pick up patterns that may help diagnose COVID-19 infections and other problems.

The ring is equipped with sensors that measure heart rate and body temperature, as well as a tiny Bluetooth radio that syncs the data it collects with a smartphone app. The Finland-based company designed the ring primarily to measure sleep quality, but it also contains an accelerometer and a gyroscope that can measure daytime movement and activity.  Together, the data is used to calculate a “readiness score” indicating whether the wearer is fully rested and prepared for the day.

Now Oura is collaborating with the West Virginia University Rockefeller Neuroscience Institute to study whether data from the ring can also be used to detect the early symptoms of COVID-19 and predict whether wearers will be officially diagnosed with the virus.  The hypothesis is that systematic changes in a wearer’s readiness score can presage illness. Rai tells Harry: “Their body temperature is starting to change. Their respiratory rate is starting to change. Their HRV [heart rate variability] is starting to change. We’ve seen people send us messages that ‘Oh, my readiness score changed, and my ring gave me a notification that I might be coming down with a fever, or my body temperature was elevated, and I should take it easy,’ and a day or two later they’ll feel symptoms, unfortunately, of being sick.”

If such patterns hold true, the National Basketball Association may be one of the first organizations to benefit. The league bought 2,000 Oura rings this summer in a bid to help protect players sequestered at Disney World for the season.

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Harry Glorikian: Hello, I’m Harry Glorikian. And this is Moneyball Medicine. The show where we meet executives, entrepreneurs, physicians, and scientists using the power of data to reinvent healthcare from machine learning to genomics, to personalize medicine. We look at the biggest trends in patient care and healthcare management.

And we talk to people behind the trends to find out where data is making the biggest difference to you. The word ring. What do you think of an engagement ring, a wedding ring, maybe a diamond ring. Sure. It’s just a little piece of circular ornament, which we wear around our fingers. But most of the time, it signifies something very important. Now let me introduce you to another ring, a ring that can monitor your health and wellness, a ring that essentially monitors you.

It is called the Oura ring, and it is like a Fitbit on your finger, but it does a lot more than just monitoring your heart rate and your calorie intake. It can potentially be used in tracking key statistics and health metrics. To help predict illness. The company is partnering with universities like the university of California, San Francisco, to help build algorithms, to help identify patterns of onset, progression, and recovery.

For diseases like COVID-19, they are partnered with the MBA and w MBA to help the league monitor the health of all their players. As we bring sports back to the country this week, we have Harpreet Rai, the CEO of  Oura, where we talk about his business. What are his plans for the pandemic, and many more topics to further understand how a ring has the potential.

To be the future of monitoring your health

Harry Glorikian: Harpreet Welcome to the show,

Harpreet Rai: Thanks for having me.

Harry Glorikian: Harpreet. I mean, you’ve gone from being the sleep tracker to the hottest device, uh, during this pandemic. Tell me a little bit about you, you know, for, for, for the listeners, you know, a little bit about your background, how did you end up in this position? And, and then we can go on to talk a little bit about the product.

Harpreet Rai: Yeah. So, um, Yeah, I think, um, you know, my history is, is, is maybe you can make a story out of it. You connect the dots, but a lot of it, I would just say is. Isn’t this, the result of my personal passion. Um, and that, that led me to where, uh, you know, I, I I’ve been messing around with wearables for a long time.

I studied electrical engineering in college. I studied the maps, um, you know, which is micro, electronic mechanical systems. And, and really, you know, that translates into sensor design. So, if you think about all these sensors today, accelerometers, um, you know, different types of micro pumps, you know, things like that, PSO, resistors, um, that that’s all memes design.

And, and I always thought when I was in college, the big application for some, the sensors would be health, right. Really out of my own interest, um, I was, uh, really into sports, um, was, you know, played a ton of soccer, but, but wasn’t as good as some of my peers. And I always just really struggled to understand why that was, you know, I felt like I had to work twice as hard to be half as good.

Um, and, and that’s when I sort of realized like, Whoa, you know, backing some of these lifestyle things like diet, how you exercise and sleep, you know, can actually give me an edge on the field. Um, and so I, I personally saw that, um, you know, I started tracking stuff in high school, like just, you know, writing stuff down on paper, you know, on like, Oh, I ran a mile time this day.

What did I eat? You know, what did I drink the day before? I mean, that’s literally how, how I got into sort of quantified self or tracking. And I think, you know, I ended up after school. Well, you know, getting veered into wall street a little bit. Um, you know, I know spending 10 years, uh, at wall street, um, you know, nine years actually at a hedge fund where I got to invest, um, along the tech sector, which was fascinating to me.

Um, and I was still obsessed with wearables trying different diets and literally, um, had ordered the ordering off the original Kickstarter. Um, or, or right after, yeah, it’s, it’s crazy and happened to me. The co-founder in a whole foods and she literally saw this guy wearing an Oura t-shirt and, and when it started talking to him, she knew I had the ring and was obsessed with it.

And you know, that, that happened over four years ago now was, was how I got involved with this company.

Harry Glorikian: There. There’s not always a straight line. Everybody always asks like, okay, what’s the, what’s the strategy, right. To go from here to there. And sometimes I just want to say like the ball bounces off the wall and you end up. You know, in the right place. I mean, some of it is directional obviously, but some of it is just what  happens, happens.

Harpreet Rai: Agree. I never planned on that, that whole foods, that my girlfriend were in on that day, we’ve never been in that whole foods. I lived in New York city for 10 years. I lived on, you know, mainly 13th street and 10th street. And so the whole foods that union square, those who know it was super close and this happened to be the whole truth. And Chelsea, the only reason we were there is there was some like event that, you know, uh, I was at and they did it. I was doing a keto diet at the time. And they didn’t have any food at the event I could eat. So, uh, we had to make a stop or I was demanding would make us stop at whole foods, you know, uh, for like dinner, uh, to grab something keto friendly and, and totally, yeah. You know, I’d rather be lucky than good. And I think this is. This is an example of that word.

Harry Glorikian: Oh yeah. Yeah. I’m, I’m, I’m, I’m always telling people like, I’ll, I’ll take luck.

I’ll make it work is hard enough, but a little luck, you know, can go a long way, but, but, you know, talk about a stroke of luck. I mean, now you’re, you’re doing deals with the MBA. Uh, you’re doing deals with, you know, the Venetian and the Palazzo casinos in Vegas. I mean, Um, but you know, for everybody listening, who may not know, right.

Tell us a little bit about, you know, what is Oura?

Harpreet Rai: Yup. Now it’s a great question. So, um, yeah, for those who don’t know, um, you know, at Oura really, you know, our mission is to empower people, individuals to own their potential, right. To, to be the best version of themselves. And we do this, we think we accomplish this by helping users understand about their health.

Um, you know, we, we, we do that with a wearable device, hold an a Oura ring, uh, and appears to a smartphone app, you know, iOS or Android. And, um, we really focused on sleep. Um, you know, sleep is really where we think, um, is an area that’s been often overlooked and frankly, the foundation of your health. Um, you know, I think your users probably know it, but everything from your natural killer T cells, uh, you know, the fight cancer, right? Those are all made in your sleep too. You know, frankly, you know, things like your memory, every single thing that you remember, those memories are all consolidated in your sleep. It’s how you learn. And so I think, you know, whether it’s physical performance to, you know, you know, Mental performance, um, really how you sleep, determines how you’re going to perform the next day.

And so, you know, we’ve really focused on that Um, and helping people understand their sleep, we think it’s foundation of your health. And so, uh, you know, we, we chose a ring to do that versus a wristwatch or another wearable form factor because we believe it’s a nice sweet spot of accuracy and convenience, um, and really comes, you know, we can dive into more detail, but a high level, you know, the pulse signal from your finger.

No from the electrical engineering standpoint has about two orders of magnitude, stronger pulse signal than, than that on, on the veins of your wrist. Um, and that’s why you see so many hospitals measuring your heart rate in SPO two on your finger. Um, you know, but, but we took this ring form factor, you know, and saw that accuracy advantage, but we also saw that convenience.

It’s easy to use. You put it on, you forget about it. You don’t have to, it doesn’t get in the way when you sleep. Most people actually sleep with their, where their wedding, you know, brings on at night. That was a pattern we observed. They don’t sleep with their watches on. Most people take off their watches before they go to bed.

Um, and you know, we made it titanium. So it’s super lightweight. Um, and that pulse signal is so strong. So as a result of battery lasts quite, quite long about a week. Um, and so, you know, that’s, that’s how the device works today and how the information is packaged and, you know, uh, we can talk about maybe it, maybe it might be interesting, you know, how, how could that data on sensors be used, uh, during, during application, like, like, you know, COVID and other fluids, but, but yeah, that’s that’s, before we dive into that, that’s basically how, how the device works.

Harry Glorikian: It’s funny. Cause I, you know, I wear my Apple watch all the time. Right? I’m  the stickler to making, making sure it’s charged and I’m wearing it. And, um, I do wish their data analytics on the back end was, was better. Uh, but it is what it is and it tracks my, and I use it to track my sleep and that’s, you know, been my biggest insight now. I have sleep apnea. So that’s maybe why I don’t remember or anything anymore. Like, um, interesting feedback mechanism, you know, I almost wish there was more intelligence built on top of it to make it more intuitive of what is sticking out. Right. Because there is a lot of data there. I don’t have the app. I don’t have the ring. I should probably get one. Tell me how the data itself. Is influencing or informing the person using the product.

Harpreet Rai: Yeah. So I think really this comes, comes down to product design. Um, you know, and it’s a hard thing, as you mentioned through so many metrics to track, so many different use cases that people would want to see a certain data point or metric. Um, we, we really focus on the remain scores, um, and in our inner device today, you know, the first one is a sleep score. What we do in the sleep score is we break down, you know, what time you went to bed? You know, how long you’re in bed, how much you were awake. Um, but then also information about sleep staging, um, you know, are you in REM sleep, light sleep or deep sleep?

Um, Yeah. Turns out that most people, again don’t know this, but, but we’re starting to hear a lot more than the medical world about it and research, which is great that certain types of stages, you know, are, are, have different functions. So for example, Your deep sleep. That’s where most of your muscle repair happens, right?

Where your natural growth hormone and testosterone are released. Right. Um, your, your body’s repairing itself, um, versus rim has a lot more to do with memory, some other functions, um, you know, that, that have to actually do with, you know, cognitive performance. Um, and, and even things like, you know, it’s, it’s now more research has been done, but things like even weight loss and your appetite, um, you know, can be directly impacted by the amount of REM sleep you get. So we would present the, the sleep score that has be sent a bunch of those individual metrics. So you’ll get a score from zero to a hundred every day.

Then we have an activity score, um, you know, pretty similar and lots of different contributors has been how often you’re moving out and tensor activity was, um, you know, are you living every hour? Are you moving? Are you sedentary for a long time then moving, you know, Uh, a lot and, and things like intensity.

Um, but then we package both of those up into a longer-term view of something called a readiness score. And I think this is, this is actually probably how most people use our user product. Um, so they’re burning a score. It takes a look at your last night of sleep and your last time of activity and that’s helpful.

Um, but then actually it takes a look over the prior two weeks of your sleep and activity to give you a little bit more of a holistic view. You know, most people can get by with one night of six hours of sleep or five hours of sleep. But if you do that for, you know, three, four or five days straight, you know, that sleep debt really, really adds up.

Um, and that’s when you get really cranky and you forget even more stuff. Um, so that’s part of the readiness score that longer-term view and that long-term, you know, long-term view for sleep activity. But then we look at, you know, a couple of physiological signals. Uh, we look at it, you know, almost bio digital biomarkers.

Do you want to think of them that way? Um, we’ll look at your heart rate and what it’s, you know, what it’s normally at versus, you know, what does that normally, you know, versus the average. Um, well, look at your heart rate variability in sort of the same way, any changes from the average, then also look at your changes in temperature and changes in respiratory rate.

And so this, this readiness score ends up sort of giving you a more holistic picture and users tell us. Hey, this is actually how it feel. If you get three nights of bad sleep, you’re going to go ahead and see, you know, that readiness a score really take a hit, right? If you actually are exercising too much and there’s too much activity, you’re not getting enough sleep, you know, you’ll see that reflected because your activity, you know, balance that that longer-term view of your activity will show that it’s out of whack for a certain norm.

And there’s a lot more strength. Um, if your heart rate is really high one night or your temperature is spiking, um, that will also affect your readiness score. So the readiness score gives you more of a holistic picture of your overall wellbeing. And, um, you know, in particularly that’s what, where we’ve seen a lot of interest, um, and people when they’re getting sick.

Um, so they’ll start to see changes in their readiness score because you know, their body temperature is starting to change or respiratory rates start to change. Their HRV is starting to change. Um, you know, even if they’re sleeping and, you know, moving back. Yeah. Normally. And so that’s, that’s what we’ve sort of, you know, has, has, has seen every flu season, people will send us messages saying, Oh, you know, my readiness score changed.

And my rank gave me a notification that it might be coming down, you know, with a fever or, you know, my body took to resolve it and I should take it easy. Um, and then a day or two later, they’ll they’ll feel, you know, Symptoms, unfortunately, of being sick. So I think, um, that’s, that’s hopefully that answers how people use the product and, you know, bigger picture too.

We also get everyone insight messages, you know, and each one of those scores. So you’ll get a little message. If your heart rate’s really elevated and we see that you weren’t exercising a lot. You know, we may suggest that, Hey, you know, it may look like you were either eating late or maybe it was alcohol and that caused your heart rate to be, you know, really elevated last night.

Um, and you know, what we found is giving people little insights and little nudges on why this data may have changed, you know, really helps them start to analyze and look at their behavior a little bit differently. There’s just a little bit more conscious and every day, um, cause they start to ask themselves like, yeah, why is that data changing?

Harry Glorikian: So I may need to get one of these just so I can say to my wife, I’m not ready today. It’s like, my score is not where it needs to be, leave me alone. Um, but

Harpreet Rai: I can just see couples start to get competitive friends, start to get competitive with it.

Harry Glorikian: What kind of people or population do you guys target? You know, what are their usual demands or concerns when they’re using the product?

Harpreet Rai: What we have found is most of our users have gravitated towards us because they, they sort of understand that sleep can help them optimize some part of their life. You know, I would say most people above our users tend not to be at, you know, Into really athletics or sports, I’d say about 20% of them. No, you know, really want to focus on, Hey, how can I be better on the field?

Or, you know, I work out really seriously and you know, I’m a weekend warrior and I want to make sure I get my 10 K time down. Um, we definitely see that. I would say, you know, 20, 30% of our users, but majority of our users really, they just. I would say there’s sort of like us, you know that, Hey, you know, I’m, I have some type of job, you know, I’m I’m, I want to make sure I’m doing it like best.

I know oftentimes between, you know, my work life and my personal life, I’m not getting enough sleep. And then it has an impact on how I feel. And so really we, we call them optimizers. They’re trying to be better at what they do. They’re trying to be a better version of themselves and they know sleep in a recovery, you know, are, are a vital part of that.

And so I think in terms of what stuff the users request from us, you know, I think, you know, accuracy is probably always one of those big things and, you know, we’ve been focusing a lot more on. Um, you know, research as a company has grown and being able to invest more into that. Cause, cause it definitely does take a lot of time and money.

Um, that’s, you know, people wanna make sure the product works and why they should use it over something else. I think the other big, you know, requests and things that we continue to keep adding to our insight and change, as you mentioned, is, is like how to. No, I help you understand why the data changed.

Like you sort of were alluding to there. And I think this intelligence layer on top, like that  can help me learn from the data.

Harpreet Rai: Um, and you know, we’ve done that with our insight engine. You will get little nudges. We want to make it even more obvious. I think our initial users were really aware and self-conscious, and, and can understand.

Or, you know, Oh, I ate a large steak dinner last night. Maybe that’s what impacted, you know, my heart rate or heart rate variability. Maybe they should try and get a different time. The next day we’d be sort of seen sort of those early adopters get that, but, you know, we need to make it easier. So even people like my mom, you know, who may not be into tracking all those kinds of things to start to understand that, Oh, that was something that maybe next time around, she can make a little bit better decision and feel, feel better the next day.

Harry Glorikian: No. Yeah, no, I, I noticed that in my, in my sleep patterns, when I’m looking at how I’m tracking and if I eat late or something like that, it, it does interrupt. I don’t get enough. I don’t get as much deep sleep as I should now, you know. I’ve had plenty of conversations with sleep, sleep specialists that these technologies are not sensitive enough to clearly indicate, you know, deep sleep versus Bubba.

But I always tell them, look, directionally. It’s correct. May not be, to be perfectly accurate as it would be in a sleep lab because you’re wired to the, you know, everything is wired. Um, but, uh, you know, it’s directionally correct. So let’s use that opportunity now to pivot, right. Because you know, we’ve been talking about health and wellness in general, right?

There’s uh, you know, different technologies out there that are utilizing digital biomarkers, uh, say heartbeat or something else to start to indicate a disease state of, of sorts. Let’s say, say it’s sleep apnea, sleigh it’s in arrhythmia, say it’s, uh, being pre-diabetic and so forth. I mean, I’m sort of reading into this and I know, you know, you can’t make medical claims because you haven’t gone through a clinical trial, but, You know, if you could imagine a future state, right. Once you have enough data and you’ve gone through these trials, like how do you see a product like this? Uh, assuming it, you know, gets through the trial the right way. How do you see it being utilized? And, and are there different disease States that you guys are looking at or are in clinical trials for.

Harpreet Rai: Yep. Harry, I think that’s a million dollar or billion dollar question that you just,

Harry Glorikian: Well, the investors are on the billion dollar question.

Harpreet Rai: I’m sure. Um, so I, I actually let’s take a step back and look at how this wearables industry has evolved. Right. Um, and, and even just maybe consumer health versus healthcare, um, If you take a look at the wearable industry, right.

I think it really started off with things that are more gimmicky, right. Things like steps. Right. So if you, if you look at Fitbit, I think they’re really smart and clever. Right. Um, you know, the first step counters are really just pedometers. I don’t know. Do you remember any of those? I don’t know if you have one.

Harry Glorikian: Oh yeah. Yeah. Yeah. Yeah.

Harpreet Rai: And so, you know, it was this annoying thing that you had to clip around your belt, like a second pager, right. Or, or your pants, or carry it, you know, your pockets somehow, and it would measure your steps. Now I think as you know, these sensors called accelerometers, you know, getting, getting back to men’s a bit, you know, these motion sensors got smaller and more power efficient.

You could put them in different form factors. And I think Fitbit was really, really smart because if you look at the, where, you know, if you look at the Y which industry there’s over 500 million launches sold each year globally, um, and you know, a couple of hundred million of them. Are actually digital watches sort of at this price point below $200.

And so it’s pretty easy to add one new sensors, you know, a step counter at this accelerometer and say, Hey, actually, you know what, now this is a smartwatch. It does more than just tell time. Right? Or, you know, essentially, you know, you can tell the time and see your steps in estimated calories, you know, on a digital device that costs less than 200 bucks.

And so that’s really how this wearable industry got started. I think it’s sensor technology improved and things like optical heart rate monitoring, using PPG sensors evolved, and even things like, you know, temperature that we have, for example, in the brain or, or other things, right? Like galvanic skin, response, sensors, things that can potentially measure stress.

Um, you know, I think as they started to you know, come to market, you know, these wearables, they’re getting traction, a step counters really on your wrist. Okay. Why don’t we throw the sensor in that sense room? And now you’re at something interesting that I think you brought up now, you’re sort of getting into more health metrics.

Right. And so what, what can you track and how does that going to evolve? So I think, you know, we’ve seen clearly that from wearables, so you can measure heart rate. Right. Um, okay. Even with that, if you look at a really granular in the Apple spent the most time on this, you know, you can measure things like AFib. Sleep apnea. Right. They’ve actually gone through some, some type of clinical data collection for a trial. Um, you know, but I had have just had SPO two leading, you know, measurement readings, not, not necessarily  saying you have apnea or not, and we’ll get into that a little bit. And I think Samsung is, you know, looking at things like hypertension and blood pressure.

So they, they released in South Korea, the new galaxy watches, I believe, you know, if you, if you calibrate with a blood pressure cuff. Um, you know, a few times every month you can actually see, you know, changes on a relative basis to, to your blood pressure, you know, during that month. Um, and it can give you a message to your head.

You may be getting hypertensive. Maybe you should go take your blood pressure reading again. Um, so I think if you think about these applications and these consumer devices, that step counters. How did they move into the medical world, right. And these chronic disease States. And so we just talked about three of them, right.

Hypertension or blood pressure, you know, if had cardiac disease, right. And then, you know, sleep apnea. If you just look at the three big guys and what they’re doing, um, I think in order to really get to the healthcare angle, well, all these devices, including us will have to. Do lots of clinical trials, right.

We’ll have to do, you know, good academic third party, validated research, eventually put that through some type of FDA process. But even then that doesn’t mean you, you may have something that just because it’s FDA approved, that’s going to fly off the shelf. Right. You have to go through things like reimbursement codes and figure out, you know, what value can insurers get out of them.

And I think that’s sort of the state we’re starting to move to. Um, you know, it, Apple, I would say, has probably done the best at an FDA approved algorithm. Right, but who’s paying for that device. It’s it’s not, you know, it’s still mainly consumers. Um, I think from the data that’s out there in the industry, um, you know, it’s still really consumer pay it.

And so I think the next step will be gathering enough data for insurers that they start to realize, right. Are employees, employers, I should say. Writing these benefits groups to realize that, Oh, you know, understanding a certain disease state can mean we saved X, Y, and Z dollars. I feel like that’s where, you know, more research, more pilots, more deployments will have to be done to collect that data.

Harry Glorikian: I always try to think of how to, how else to play the game. Right. And so everybody likes thinking about the game, the way it’s being played. Right. And I’m watching the game moving in a different direction. In other words, you say Apple, they want to sell more watches. They want to sell more phones. They want you to think that their environment is the health capital of the world.

Right? It’s not necessarily the function that they’re selling. It’s the whole ecosystem that they’re selling. Now at the same time, if we’re moving into a market, that’s healthy care. As opposed to sick care, an early warning could be, you know, embraced by not an insurer necessarily, right. But insurer provider system that wants to keep you healthy.

So if you think CVS and Aetna, right, every time you go into the hospital, they pay. However, if they can catch things early and help you stay healthy, you’re paying your premiums and you’re cutting coupons. So it’s interesting, right? I mean, I know that right now, we’re, we’re theoretically straddling two sides of a, you know, two boats at the same time.

But I do see that this whole thing is, is starting to shift in a different direction. It’s very difficult. I think for. People to appreciate, see, I mean, I get a lot of pushback from people, especially medical professionals, but it’s, it’s, I think it’s moving in, in a way that when the shift happens, I think people are not going to be as prepared for it as they should be.

I mean, you guys are doing this, this project with a Rockefeller neuroscience Institute, right. Where they developed an AI model for looking at different symptoms. I think they showed that they could sort of. See things days, uh, before it really materialized with, uh, you know, if I’m reading this data correctly, 90% accuracy.

Harpreet Rai: Yep. Yeah. So, I mean, there’s a lot there. I think, um, Starting on the research. Yeah. You know, so when we saw COVID happening, um, you know, and given what we’ve seen from our users and their data changing and their readiness scores, you know, we felt like, especially since we have temperature and other wearables still that, you know, we, we really need to do what we can as a company to, to help.

Um, and so we, we, you know, we announced two studies, you know, first one was with UCLA. Um, and you know, the dealer one is pretty close simultaneously, nearly was with Rockefeller neuroscience too at West Virginia university. And yeah. You know, WVU did put out or, and I, you know, WVU put out that, that initial press release from the early data.

Uh, and, and what they’ve seen is, you know, sort of what we have heard from our users, right. That we’re seeing changes in people’s data up to three days in advance of when they feel symptoms. And, you know, to your point on getting back to this bigger picture. Healthcare and you know, or, you know, health care for sick care.

I think that is where the industry is gonna head, right? Like, hey, by using this technology, you know, you can understand that this could function as the, you know, Gaslight or the inch of light, right. Or check oil light on your dashboard for health. Right. That right now today, healthcare is, you know, we wait until you have a heart attack.

And then, and then do something about it. We wait until the car breaks down. It doesn’t make a lot of sense. I think what this new technology can show like ours and like other wearables that, Hey, actually, something may be off and your, your check oil lights on, or your, your brake light is, you know, it looks like something’s wrong and let’s give the consumer a heads up so they can go seek the medical attention that they need.

Um, right before waiting until the engine breaks down, the car breaks down. So I completely agree. That’s that’s the way. I think, you know, we’ve seen this world evolve and, and frankly, I think it’s partly. Because of necessity. And if you look at the healthcare dollars in this country, right, it’s nearly 20% or over maybe now 20% of our GDP spent on healthcare dollars growing double digit.

Um, yet life expectancy, if anything in the U S is, is probably looks like stranded decline. You know, people are, you know, more sick than ever are more obese than ever. Right. Um, so clearly the sick care system of wait until your car breaks down, isn’t working anymore. It’s just breaking. Right. And literally look at the dollars.

If it shows you it’s almost growing, you know, so big, like how big is it going to get? Um, and, and so consumers on the other hand are going out and finding out what can I do about it? You know, forget, I don’t want to wait until this. You know, they, my car breaks down or my heart breaks down and I’m in the hospital and, you know, and, and really bad quality of life.

So what can I do? Um, and I think that’s where, you know, we’re seeing consumers willing to spend. And other businesses willing to innovate as you pointed out CVS, Aetna, right. Um, to get ahead of that disease state, what can I do with my own money and my own empowerment? And then I, we hear the same pushback sometimes, you know, for medical professionals.

And I, I totally understand it. They’re not trained to look at, you know, this new type of data they’re trained in the medical system, which unfortunately today is the security system. Right? So looking at things, preventative, you know, your average doctor doesn’t take classes in. Exercise and sleep and diets, right?

That’s that’s not what they learned. That’s not what they studied in college in medical university. So I definitely think it’s this need of people being unhealthy, yet spending more dollars that’s causing the system really to break doubt. And people really are their own, you know, yearning, wanting to go spend it and be healthier.

And, and you know, other businesses realizing that too. So, so that, that’s where I think the industry is going.

Harry Glorikian: Yeah. And I mean, we, you know, it’s funny because we always talk about, you know, nation’s enemies, stuff like that. I can tell you right now, if, if this, if that curve of spending continues will bankrupt the country.

So it really won’t matter. Right. Um, but, but on the other hand, you are seeing certain insurers, you know, we’ll pay for the Apple watch, right? If you wear it on a regular basis, Um, you know, it here’s the price and it starts going down right until it basically becomes zero. And the watch is yours. You can, you can see a direct where, uh, employers, uh, or insurance companies are seeing the benefit of a healthy care environment.

The other thing is, is look at, look at under COVID right. I have a patient out in the field, right. I’m using telemedicine. Telemedicine is not enough. I need a, a way to measure things in the wild to be able to then manage that patient better. And so, you know, whether it’s the Oura ring or the Oura ring plus the weight scale plus, you know what I mean?

It’s, I, I, I don’t think it’s necessarily one device, but it’s a integrated view, which now is completely and totally possible.

Harpreet Rai: I think, you know, really, I think COVID might be the straw that broke the camel’s back, right? Because to your point on the enterprise is, you know, unfortunately COVID has now become part of your business plan.

Whether you like it or not learning how to deal with this as a business, doesn’t matter what the size or scope of your business, right? Whether you’re, you know, Ford automotive, whether you’re at the NBA, right. Or whether you’re a small local business, right. COVID unfortunately, this pandemic has impacted how you and your team work.

Uh, just, just, you know, point blank. Um, it’s affected everyone. And so I think. This healthy environment that you alluded to right now, that’s what enterprise is trying to figure out. Well, how can I get back to work? That’s safe and healthy for people to be in. Right. And so I think that’s, that’s really where we saw the interest of people like the Las Vegas sands, as you mentioned, right.

That, um, you know, nation plots and stuff like that. Right. Um, and, and start to. Come forward and say, well, Hey, no, we got to reopen our business. We have to do this in the safest way possible. Let’s look at new technology. Now it can help and same with the MBA. And so I think, you know, if you look at the industry today, Reese for wearables, I think Fitbit’s the only company that sort of has put this data out publicly.

So I think last year, you know, Fitbit sold in 2019, something like 16 million devices. Um, they have a segment that they talk about. Yeah. And every couple of quarters, you know, and earning calls called Fitbit health solutions, FHS. And that, that was about 1 million wearables last year, right? So about 7% of their business, but I think it grew something like 50%, you know, you’re a year.

Um, and, and I think that’s exactly what you said they’re selling into. You know, employers they’re selling into healthcare benefits plans because their insurers are starting to realize all like, no, if these individuals are healthier, maybe it’s they set certain goals, right. Um, like steps and activity, you know, maybe hopefully one day things like sleep right.

That we see that actually their premiums are less right. And their employer says, Oh wait, that they’re more productive in the workplace. They’re getting more done. They’re better workers. And, and, you know, uh, in the case of COVID too, you know, what we’re seeing is. Imagine if your workforce gets sick, right.

You can bring people back to work and, you know, you have an outbreak, right. 10, 20, 30, 40% of the workforce may be out. Right. And so I think, you know, that’s where we’re seeing, okay. People are willing to invest to keep people more safe because they know ultimately it’s going to drive the bottom line. And so, yeah, I do think, you know, really, it might be an accelerator on the whole adaptation of how insurers look at some of these.

You know, not medical devices and how employers look at some of these, you know, these consumer devices too, to see that how it can actually benefit their business and their bottom line.

Harry Glorikian: Yeah. I’ve got to give a talk to a bunch of medical systems pretty soon. And, and you know, that, that the prognosis is, is not positive for the status quo, right?

I mean, uh, revenues are down, you know, profitability between now and 2030 is, is, it looks like it’s tracking downward on EBITDA. Right. Um, the models short of shifting, you know, much faster than it normally would because of COVID and the adoption of technology or the investment in technology needs to go up to bridge the gap and still be able to provide services.

But, you know, at the same time, like I said before, I think the model is up for change. It’s interesting to look at new models as opposed to. Uh, yeah, I got reimbursement and yeah, I, you know, somebody’s gonna, you know, it’s the same old thing. Right. Which, which is great. But I do think that there’s an accelerant if you shift the model slightly.

Harpreet Rai: Yeah. I agree. Um, I really think it’s, it’s interesting here, you know, from our perspective, right? Like, like with COVID I think. We’re  seeing immediate need, you know, why people are willing to buy or brings for their employees. Right. And willing to spend those dollars is because we’re right now testing super expensive.

Right. These tests, um, for, at least in the us, unfortunately are still like North of a hundred dollars product close to 150 bucks. And so the question is, okay, well, you know, they’re, they cost a lot, you know, how do I deploy them? Do I, so alphabetical order, uh, every week, every month, every year, you know, like, huh.

How, how frequently should I be doing this? You know, if you test every day, And a hundred bucks a day, you know, you’re, you’re looking at 25 grand, if you just sort of count the weekdays. Right. Right. Um, so, you know, you know, 52 weeks or 50 work weeks, right. Times five workdays. Right. So, so that’s 25 grand, you know, what, if you could use something like Oura that can tell you, Hey, based on all the data we’re seeing, here’s the top 1% of your population that’s at risk today.

Just focus on testing those people with the limited tests that you have. Um, and so what we’re actually seeing is I think a real big interest because. How you test your employees, you know, in a back to work situation. Right. Um, to make sure that, you know, we’re keeping the environment safe when we’re testing frequently enough, but do that in a, in a way that, you know, can be cost manageable because most employers right now, can’t to your point on even dumping down, right.

When you’re paying down, you take $25,000, you know, increase per employee. No most companies can’t do that.

Harry Glorikian: No, no, no. I see somewhere. Sort of a, uh, an interesting hybrid, right? So if you could pool test, right. Um, not in Texas, right? Like right now, for sure. And definitely not in California right now, for sure.

But someplace like Massachusetts, right. Where our numbers are under control, you do some pool testing plus have something like an Oura ring. Right. You sort of got a surveillance technology. Plus you’re getting some hard numbers. Um, on some sort of basis, and then you could sort of control until you get to a vaccine, which, I mean, I’m not expecting, you know, this to get better until next March is sort of my, you know, line in the sand.

Harpreet Rai: I think we’re seeing that same. It’s funny. You mentioned pool testing. You know, one of the, one of the researchers that I think is doing excellent work out there, is it Dr. Harland? It’s, you know, um, not too far away from mass, but you know, um, right there in yell. So. Um, I think, you know, they’re actually doing some really cool work and, and, and I know they’re, they’re working with the FDA and also, you know, uh, even the NBA as, as, uh, you know, pilots study for pooled, you know, pool testing, a way to drive these costs down and like between that and some wearable devices, you know, like your rank, I think you could have a pretty comprehensive solution that can help you track, you know, population type health in your workforce.

Um, you know, something that’s affordable and deployable in a Greek, you know, situations like where it’s breaking out, unfortunately like it is, you know, in Texas or California or some of these States, unfortunately, uh, yeah, you’re going to just have to really crank up the testing and you should write those high density areas that are seeing, you know, high, positive test rates.

That’s where you should be deploying as many tests as possible as economically possible. Yeah, it’s been, it’s been really cool to see how different organizations are starting to attack this problem. Cause, cause no, one’s really figured it out yet.

Harry Glorikian: Oh no, no, no, no, no, no, no. I mean, everybody’s like, you know, this is ground zero for learning and, and really, I mean you’re watching, you know, either organization that have good leadership or don’t have good leadership, right.

This is the time when you’re sort of in a, in a, a combat situation for lack of a better. Descriptor. Um, but getting back to the product. So  you know, right now it’s got, let’s see, uh, what, uh, gyroscope, accelerometer, temperature tracking. I’m assuming you’re going to try and stick something more into that as time goes on.

Harpreet Rai:  Yeah. Always looking at more. Um, so yeah, right now we have optical LEDs and for LEDs that are, are tracking heart rate and an infrared receiver. Um, so, you know, those are three of the sensors with two LEDs, one receiver. Um, we have three temperature sensors in there. We have accelerometer, gyroscope, and then, um, you know, we also have a microprocessor, um, right.

As like in a, in a battery, like any sort of wearable would have, um, yeah. In terms of new sensors, man, there’s so many, so many cool applications, you know, there’s SPO too. Um, obviously, you know, that’s getting a lot more attention during, during, you know, or respiratory pandemic, like respiratory disease pandemic as some of, you know, thought about and seen data change with COVID.

Um, there’s things like EDA or GSR sensors, you know, electrodermal activity or galvanic skin response. I think there’s some good research out there on stress and how some of those things can change. Um, so yeah, I mean, you know, we’re, we’re always looking at, at, at different applications and, and, or, you know, investing more and more, um, as a company has grown into new types of sensors and how we can use them for, for different, you know, really help functionality.

Harry Glorikian: So, when do you expect, um, I guess, you know, cause there’s a bunch of people doing all these different, uh, trials with your product. W when do you expect to see the first sets of data? Yeah. Um, actually

Harpreet Rai: I think, um, yesterday, so, you know, As you mentioned a couple of weeks ago, Rockford near census, you’ve put out a press release just with our early findings, um, which was, you know, pretty impressive I’d say, you know, seeing changes in data up to three days in advance of symptoms. I think, you know, the UCF study, um, they, you know, that’s, that’s now grown quite a bit. We have over actually 70,000 people in that study now. Um, you know, that are using order rings and filling out symptom card survey, um, which is, we never thought it would be that big.

So that’s, you know, that’s the latest numbers that, that we’ve heard, which is just incredible. And so really think our users for contributing their data and filling out the symptom cards every day. Um, So I think, you know, it’s probably gonna be sometime in the fall where we’d see some data, but I do know actually it’s UCF and actually UCS D and is doing a lot of the data science work, um, and professor Ben smar at HGSI, um, you know, the data science Institute at UCLA, they actually did just put out some initial data yesterday, you know, sort of in an independent.

Uh, like an open access publication. So, um, I haven’t even reviewed it yet. Myself. I’ve been been so swamped. I think it hits sometime late night, yesterday or early this morning, but, um, I think the initial data looks pretty positive that, you know, you can see these changes. No, perhaps even greater than three days in advance, where, where you’re seeing changes in your physiology change, you know, um, before, you know, before you feel symptoms.

So I, I hope that, you know, we have enough data collected by, you know, early fall where we can have a full publication out, you know, we’re, you know, you CSF can, can get that out. But, um, I also know at the same time, as we’re seeing COVID increase in States like Texas and California, as you noted, and we have.

You know, a high population of orange users that, you know, there’s potentially more and more data that can, that can always make algorithms or any of the findings stronger. So I think it’s going to be the balance that the researchers have to, you know, figure out when they have enough data to put something out, you know, versus, you know, trying to get better and more data all the time.

Harry Glorikian: Yeah. I mean, this is, you know, this is software. I always think to myself, like, you know, it’s, it’s ever evolving, right? You put a stake in the ground, but it’s, you know, underneath that strike that it’s moving forward, right. Because there’s always ways to tweak, advance and drive forward. Um, which is interesting when you’re, you know, in the healthcare world, everybody expect like, stop we’re done. Don’t do anything else. And software just. It doesn’t work that way.

Harpreet Rai: Yeah. No, completely agree. It’s again, it’s a new science, right? I think as these wearables are more digital, right. Two-way communication. Right? Um, you, you, that data sets always are keep crying, right? If your users are growing, um, you’re, you’re going to see more and more data, which can always be helpful.

So encouraging it’s like, when do you, when do you put pencils down? I think the answer is you certainly never do you, if you have enough stuff to put out there, you put it out there and then you keep trying to keep getting better and better.

Harry Glorikian: Yeah, this is where the FDA, I think, you know, has always got to be creative because this is it’s changing all the time.

Um, and, and, you know, fortunately, or unfortunately they got to keep up with it. Um, but it it’s, you know, it, it is a fun space. I would tell you, I mean, you know, this sort of stuff I think is going to change people’s health in a way that most people have very difficult time wrapping their head around.

Right now, um, you know, I see this integrated with something like, you know, a smart speaker and, you know, just a, a integration of product that can then almost speak to you as a patient and help you manage your health better.

Harpreet Rai: Yeah, yeah, no, I think that’s where it’s going to go. Right. Getting this data in usable insights for users and then amplifying.

You know, the communication means to these are to your point. You know, you can totally imagine your Alexa, you know, when you wake up in the morning, right. Or Google, you know, your Google home device, like, Hey, you know, this is how you slept last night. Here’s what you’re doing. Hey, maybe we should try to make sure that you.

You know, remind people to take their medicine, stuff like that. So I completely agree. That’s where this space is. It’s going to keep getting more and more connected, um, you know, and hopefully better for, for users.

Harry Glorikian: Well, this has been great. Um, hopefully when this whole thing is over, we can get together and, and, uh, you know, have a cocktail or a beer or water, depending on how we slept the night before. I don’t know when that’s going to be, cause I’m not getting on a plane anytime soon. Um, but, uh, and my wife has said to me, you know, you’re sleeping better. You’re not getting on planes. I mean, so it’s obvious that there’s a connection, but you know, I wish I wish you guys great success.

And uh, you know, I look forward to, to staying in touch and hearing how the story evolves.

Harpreet Rai: Yeah, no, likewise, thanks so much for having us on the podcast today and frankly, for doing what you do. Um, I think this space is emerging, it’s evolving and, you know, uh, we’ll, we’ll see how it keeps going and you know, there’s a lot yet to be figured out, but, but I think that’s what makes it fun and exciting.

Right. And, you know, ultimately I think it’ll, it’ll improve people’s lives. So, you know, um, we’re, we’re happy to be part of that mission, um, and, and agree that it’s going to be a solution of companies and devices and an ecosystem working together to let me make the best solution for consumers.

Harry Glorikian: Awesome.

Thank you so much.

Harpreet Rai: Cool. Thanks

Harry Glorikian: And that’s it for this episode. If you enjoyed Moneyball Medicine, please head over to iTunes, to subscribe, rate, and leave a review. It is greatly appreciated. Hope you join us next time until then farewell.


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